In Bangkok’s sprawling outer suburbs, the Emergency Home offers a secure haven, providing crisis care and shelter for adolescent and teenaged girls like Fern who find themselves unexpectedly pregnant, desperate and with nowhere else to go. Fern is 18, the youngest here is just 13, and the other residents fall somewhere in-between.
Although Thailand is classified as an upper middle-income country, with aspirations to reach fully developed status within the next 20 years, its teenage pregnancy statistics remain high. About 1.6 million babies were born to teenage mothers over the last 15 years, with a 54% increase from 2000 to 2014. In Thailand, as in so many countries across Asia and the Pacific, access to vital and comprehensive sex education at a young age is difficult, as is access to sexual and reproductive health services for young people.
Ten months ago, Mae Esparcia, 30, gave birth to her first child in Cavite, Philippines. After her delivery, Esparcia, a garment factory worker, decided to start using contraceptive pills, which she received for free from her workplace. Millions of other Filipino women would also like to plan the timing and the size of their families, but are unable to do so amid a sociocultural context long hostile to family planning, including modern contraception for which 18% of married women have an unmet need.
Many dimensions of inequality, millions of women impacted
These are just two women whose stories, along with those of millions of others in Asia-Pacific and globally, illustrate how inequalities remain at the heart of the challenge to access and achieve optimal sexual and reproductive health and rights, especially for the most vulnerable and marginalised.
Economic disparities are only one aspect of inequality. Many other dimensions – social, racial, political, institutional – are in the mix, collectively blocking advancement for people on the margins. Two such critical factors are gender inequality and inequalities in realising sexual and reproductive health and rights.
Unless we address these inequalities, many women and girls will remain mired in a vicious cycle of poverty, diminished capabilities, unfulfilled human rights and potential – not only in developing countries where gaps remain the widest, but in developed countries as well where deep pockets of inequality also persist.
For instance, typically the richest 20% have the greatest access to sexual and reproductive health care, and the poorest 20% have the least. Moreover, the poorest 20% of girls are nearly four times more likely to give birth between the ages of 15 and 19 in Asia-Pacific. Women in rural areas are three times more likely to die giving birth than women in urban areas, while 43% per cent of pregnancies in developing countries are unintended, with poorer, less-educated and rural women particularly at risk.
The World Economic Forum’s global gender gap index captures differences between men and women in accessing resources and opportunities—for example, in income and labour-force participation, education, health and political empowerment. Of the 142 countries the index covered in 2016, 68 had larger gender gaps than the previous year. Inequalities in access to sexual and reproductive health and rights undeniably contribute to these gaps.
Three messages, three steps
This year’s flagship State of World Population Report from UNFPA, the United Nations Population Fund, spells all of this out very clearly. “Worlds Apart: Reproductive health and rights in an age of inequality” imparts three overarching messages backed up by irrefutable data.
First, unless we reduce inequalities in women’s reproductive health and rights, the world will fail to achieve the UN's Sustainable Development Goals that underpin the 2030 Sustainable Development Agenda, and the most important goal, poverty reduction – SDG 1 - will be blocked. When women are able to control their fertility, including by avoiding early marriage or unintended pregnancy, they can finish their education, enter the paid labour force and gain more economic power.
Second, we must heed the call of the SDGs to first reach those who are furthest behind if we are to realise shared prosperity. This can’t happen without individuals and couples in the poorest segments of a country gaining access to reproductive health and family planning services. We need to prioritise adolescents, stop child or early marriage and prevent teen pregnancies. Countries with large youth populations can benefit from the “demographic dividend” through investing in education and delaying childbearing, to the benefit of future generations.
Third, we must implement a package of concrete actions that require governments to act together with civil society and, increasingly, in partnership with the private sector. These actions include tearing down barriers – discriminatory laws, norms or service gaps – that prevent adolescent girls and young women from accessing sexual and reproductive health information and services. The poorest women must be reached with essential, life-saving pregnancy, maternal and newborn healthcare. And all unmet demand for family planning must be met, prioritising the poorest women.
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For 18-year-old Fern in Bangkok, an academically gifted student, this means following through on her determination to complete her education and eventually attend university. Recognising the inequalities that contribute to teen pregnancy, Thailand’s government has approved a new bill with UNFPA support which aims to improve sexual and reproductive health education across the country, with the collaboration of all key ministries.
And for 30-year-old Mae Esparcia in the Philippines, this means the ability to continue to obtain contraception through her private sector employer, Hamlin, whose UNFPA-mentored voluntary and confidential workplace family planning programme enables her and thousands of its other employees – over 75% of them women – to take control of their futures. It’s also good business: high employee turnover and significant absences due to unplanned pregnancies affect Hamlin’s bottom line.
When millions of women struggle with deprivation, the price is steep for societies and economies. The prospects dim for realising human rights and achieving a stable, fair society and an inclusive, sustainable economy.
An alternative course - one that tackles multiple inequalities, including those in sexual and reproductive health - can unleash significant benefits, including health, human capital development and the eradication of poverty.
The choice is clear - for Asia-Pacific, and for the world.